Trends and impact of intravascular ultrasound and optical coherence tomography on percutaneous coronary intervention for myocardial infarction.

Background: Intravascular imaging with either intravascular ultrasound (IVUS) or optical coherence tomography (OCT) during percutaneous coronary intervention (PCI) is associated with improved outcomes, but these techniques have previously been underutilized in the real world. We aimed to examine the change in utilization of intravascular imaging-guided PCI over the past decade in the United States and assess the association between intravascular imaging and clinical outcomes following PCI for myocardial infarction (MI). Methods: We surveyed the National Inpatient Sample from 2008 to 2019 to calculate the number of PCIs for MI guided by IVUS or OCT. Temporal trends were analyzed using Cochran-Armitage trend test or simple linear regression for categorical or continuous outcomes, respectively. Multivariable logistic regression was used to compare outcomes following PCI with and without intravascular imaging. Results: A total of 2,881,746 PCIs were performed for MI. The number of IVUS-guided PCIs increased by 309.9 % from 6,180 in 2008 to 25,330 in 2019 (P-trend < 0.001). The percentage of IVUS use in PCIs increased from 3.4 % in 2008 to 8.7 % in 2019 (P-trend < 0.001). The number of OCT-guided PCIs increased 548.4 % from 246 in 2011 to 1,595 in 2019 (P-trend < 0.001). The percentage of OCT guidance in all PCIs increased from 0.0 % in 2008 to 0.6 % in 2019 (P-trend < 0.001). Intravascular imaging-guided PCI was associated with lower odds of in-hospital mortality (adjusted odds ratio 0.66, 95 % confidence interval 0.60-0.72, p < 0.001). Conclusions: Although the number of intravascular imaging-guided PCIs have been increasing, adoption of intravascular imaging remains poor despite an association with lower mortality.

From childhood obesity risk to healthy growth in the U.S.: A 10-year social work research & policy update.

Childhood obesity is a major health issue and a prominent chronic health condition for children in the United States (U.S.), caused by a multitude of factors. Most existing models of childhood obesity prevention have not worked, yielding little to no effect on improving weight status or the proximal health behaviors most attributed to obesity risk: nutritional intake, physical activity, sedentary behaviors, and sleep. There is an urgent need for new approaches to prevent health disparities that are responsive to impacts of economic inequality on healthy child growth in marginalized populations. In this Short Commentary, a social justice update is provided to motivate a new generation of research that promotes equitable and healthy child growth under present-day social, economic, and political circumstances. Social work-specific research and policy recommendations are provided to guide future research that targets underlying social and economic determinants of weight-related health disparities in childhood. Recommendations include research on cross-disciplinary metrics to better capture reductions in health disparities and the development and testing of policy and system interventions that address structural issues and strengthen health resources in marginalized communities. Progress in reducing disparities in childhood obesity will likely remain inhibited until recommendations from social work research are incorporated to strengthen existing medical and public health models and redirect the childhood obesity epidemic toward equitable, healthy child growth.

Exploring racial disparities on the association between allostatic load and cancer mortality: A retrospective cohort analysis of NHANES, 1988 through 2019.

Background: Several studies suggest that chronic stress may be associated with increased risk of cancer mortality. Our study sought to determine the association between allostatic load (AL), a measure of cumulative stress, and risk of cancer death; and whether these associations varied by race/ethnicity. Methods: We performed retrospective analysis using National Health and Nutrition Examination Survey (NHANES) years 1988 through 2010 linked with the National Death Index through December 31, 2019. We fit Fine & Gray Cox proportional hazards models to estimate sub-distribution hazard ratios (SHRs) of cancer death between high and low AL status (models adjusted for age, sociodemographics, and comorbidities). Results: In fully adjusted models, high AL was associated with a 14% increased risk of cancer death (adjusted (SHR): 1.14, 95% CI: 1.04-1.26) among all participants and a 18% increased risk of cancer death (SHR:1.18, 95% CI: 1.03-1.34) among Non-Hispanic White (NH-White) adults. When further stratified by age (participants aged <40 years), high AL was associated with a 80% increased risk (SHR: 1.80, 95% CI: 1.35-2.41) among all participants; a 95% increased risk (SHR: 1.95, 95% CI: 1.22-3.12) among NH-White adults; a 2-fold (SHR: 2.06, 95% CI: 1.27-3.34) increased risk among Non-Hispanic Black (NH-Black) adults; and a 36% increased risk among Hispanic adults (SHR: 1.36, 95% CI: 0.70-2.62). Conclusions: Overall, the risk of cancer death was associated with high AL; however, when stratified among NH-Black and Hispanic adults this association was slightly attenuated. Impact: High AL is associated with increased risk of overall cancer death, and future studies should delineate the association between AL and cancer-specific mortality to better understand the causal mechanisms between cumulative stress and cancer.

Acculturation and depression are associated with short and long sleep duration among Mexican Americans in NHANES 2005-2018.

Acculturation and depression are linked to poor sleep quality and sleep problems that may explain ongoing health disparities for Hispanics/Latinos. We examined the associations of acculturation, depression, and sleep duration among the Mexican American population. We used a multinomial logistic regression model on cross-sectional data from the 2005-2018 National Health and Nutrition Examination Survey on 4,700 Mexican American adults aged ≥18 years old. The outcome of sleep duration was operationalized as short (≤6 h), optimal (7-8 h), and long (≥9 h). Acculturation was constructed using years living in the U.S. and language(s) spoken at home (majority Spanish, English and Spanish equally, majority English). Depression severity was assessed using the 9-item Patient Health Questionnaire. Covariates included gender, age, marital status, income, and U.S. citizenship. Speaking majority English (Adjusted Odds Ratio (AOR) = 1.23; 95% Confidence Interval (CI) = 1.00-1.52) and mild (AOR = 1.63; 95%CI = 1.32-2.01), moderate (AOR = 1.94; 95%CI = 1.43-2.63), and moderately severe/severe (AOR = 2.58; 95%CI = 1.72-3.88) levels of depression were significantly associated with short sleep duration. Living in the U.S. for ≥10 years (AOR = 1.61; 95%CI = 1.17-2.23) and moderately severe/severe depression (AOR = 2.30; 95%CI = 1.34-3.93) were significantly associated with long sleep duration. Our results provide additional evidence of a link between acculturation, depression, and short and long sleep duration among the Mexican American population. Understanding the sleep health of this population is important for informing future public health interventions and research. Additional investigation into the relationship between acculturation/depression and other sleep health measures among this population is warranted.

Enhancing Prolonged Exposure therapy for PTSD using physiological biomarker-driven technology.

Prolonged Exposure (PE) therapy is one of the most efficacious, evidence-based treatments for posttraumatic stress disorder (PTSD). A key component of PE involves in vivo exposures (IVEs) during which patients approach situations or activities in "real life" that are safe but avoided because they elicit a fear response. Despite their critical role in treatment, little research has focused on IVEs. This gap in knowledge is primarily due to the fact that IVEs are typically conducted by patients in between therapy sessions, leaving clinicians reliant upon patient self-report. This approach has numerous shortcomings, which the current study addresses by leveraging technology to develop an innovative device that allows for physiological, biomarker-driven, therapist-guided IVEs. The new system enables clinicians to virtually accompany patients during IVEs and provides real-time physiological (heart rate, skin conductance) and self-report (subjective units of distress) data that clinicians can use to modify the exposure and optimize therapeutic value. This Small Business Innovation Research (SBIR) Phase I project aims to: (1) integrate physiological sensors and live audio/visual streaming into a system for clinicians to guide patients during IVEs; (2) determine feasibility and acceptability of the system; and (3) conduct a pilot randomized clinical trial among veterans with PTSD (N = 40) to evaluate the preliminary efficacy of the system in reducing PTSD symptoms during PE. This paper describes the rationale, design, and methodology of the Phase I project. The findings from this study have the potential to innovate clinical practice, advance the science of exposure therapy, and improve clinical outcomes.

A systematic review of trucking food, physical activity, and tobacco environments and tractor-trailer drivers' related patterns and practices in the United States and Canada, 1993-2021.

Truckers in the United States (U.S.) and Canada are at high risk for noncommunicable disease. Although trucking built environments have been highlighted for intervention, no systematic review has assessed aspects of trucking environments that may influence food, physical activity (PA), and smoking patterns/practices. The purpose of this systematic review was to characterize the state of the science on trucking food, PA, and tobacco environments and to examine truckers' food, PA, and tobacco patterns/practices. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used. Five databases were selected for searching in April 2020 and 2021 using key terms constructed by a librarian. Peer-reviewed research with data about U.S. and Canadian truckers' (i.e., drivers operating 18-wheelers or tractor trailers) food, PA, and/or tobacco environments and related patterns/practices were included. Quality was assessed using the Mixed Method Appraisal Tool. Thirty-eight studies were identified. Results included data from at least 16,600 truckers and 282 trucking settings in the U.S. (n = 32) and Canada (n = 6). Most studies were classified as quantitative descriptive and of poor quality (average score 3 of 7). The few studies (n = 4) that measured trucking food and PA environments characterized trucking sites as poor. Fifteen (47%) presented data about truckers' perceptions of food or PA environments and highlighted prominent environmental barriers. Truckers' food, PA, and smoking patterns and practices suggested poor diet quality, sedentary practices, and a high prevalence of smoking. The science of trucking food, PA, and tobacco environments is underdeveloped and requires much more focus using validated measures.

Intent to get vaccinated against COVID-19 pandemic and its associated factors among adults with a chronic medical condition.

BACKGROUND: Vaccination intent is defined as the willingness to get vaccinated against a COVID-19 pandemic in a situation where the vaccine is available at no cost. Nevertheless, even with the availability of COVID-19 vaccines, some part of the public is not expected to get vaccinated, mainly due to a phenomenon known as vaccine hesitancy or lack of intention. Furthermore, there is little information available on the intention of people with chronic medical conditions about the COVID-19 vaccines in Ethiopia. OBJECTIVE: The study aimed to assess the intent to get vaccinated against COVID-19 and its associated factors among adults with a chronic medical condition. METHOD: An institutional-based cross-sectional study was conducted from February 15 to March 15, 2021. Simple random sampling was employed to get representative samples. Data were collected by using a structured questionnaire through face to face interviews. The data were entered by Epi Info version 7 and analyzed with SPSS version 20. The data were analyzed by using binary logistic regression. Those variables with a P-value of ≤ 0.05 were considered significantly associated with the outcome variable. RESULT: In this study, 423 study participants took part with a response rate of 100%. The mean age of the study participants was 50.07 (SD ± 13.7) with a range of 18-85 years. The intention to get vaccinated against the COVID-19 pandemic was 63.8% [95% CI (58.6-68.2)]. In the multivariable analysis the variables, retiring from the job was [AOR = 2.65, 95% CI (1.02-10.35)], having health insurance coverage [AOR = 1.38, 95%CI (1.04-3.65)], being in the high socio-demographic status [AOR = 1.67, 95%CI (1.01-2.78)], being confident with the Country's health care system [AOR = 2.00, 95%CI (1.15-3.49)], and having good knowledge about COVID-19 [AOR = 6.59, 95% CI (4.02-10.78)] were significant predictors of intent to get vaccinated against COVID-19 pandemic compared. CONCLUSION: The intention of getting vaccinated against the COVID-19 pandemic was relatively low. There has to be a great effort by the health caregivers as well as the government to increase vaccination intake, particularly for these priority groups.

Quantitative methods for descriptive intersectional analysis with binary health outcomes.

Intersectionality recognizes that in the context of sociohistorically shaped structural power relations, an individual's multiple social positions or identities (e.g., gender, ethnicity) can interact to affect health-related outcomes. Despite limited methodological guidance, intersectionality frameworks have increasingly been incorporated into epidemiological studies, both to describe health disparities and to examine their causes. This study aimed to advance methods in intersectional estimation of binary outcomes in descriptive health disparities research through evaluation of 7 potentially intersectional data analysis methods: cross-classification, regression with interactions, multilevel analysis of individual heterogeneity (MAIHDA), and decision trees (CART, CTree, CHAID, random forest). Accuracy of estimated intersection-specific outcome prevalence was evaluated across 192 intersections using simulated data scenarios. For comparison we included a non-intersectional main effects regression. We additionally assessed variable selection performance amongst decision trees. Example analyses using National Health and Nutrition Examination Study data illustrated differences in results between methods. At larger sample sizes, all methods except for CART performed better than non-intersectional main effects regression. In smaller samples, MAIHDA was the most accurate method but showed no advantage over main effects regression, while random forest, cross-classification, and saturated regression were the least accurate, and CTree and CHAID performed moderately well. CART performed poorly for estimation and variable selection. Sensitivity analyses examining the bias-variance tradeoff suggest MAIHDA as the preferred unbiased method for accurate estimation of high-dimensional intersections at smaller sample sizes. Larger sample sizes are more imperative for other methods. Results support the adoption of an intersectional approach to descriptive epidemiology.

The influence of diagnosed mental health conditions and symptoms of depression and/or anxiety on suicide ideation, plan, and attempt among college students: Findings from the Healthy Minds Study, 2018-2019.

BACKGROUND: Approximately 11% of 18-25 year-olds report thoughts of suicide. Additionally, suicide is the second leading cause of death in college student populations. We sought to evaluate the relationship between diagnosed mental health conditions and current symptoms of depression and/or anxiety and suicidality in the past year. METHODS: Healthy Minds Study (HMS) 2018-2019 data from 38,757 college students were analyzed. The PHQ-9, GAD-7, and prior mental health condition diagnoses were used to create a suicidality severity index and we determined how these associations varied by race/ethnicity, gender, and sexual orientation. We also assessed non-suicidal self-injury (NSSI) outcomes in the past year. RESULTS: Students with both a mental health condition diagnosis and current moderate/severe symptoms of depression and/or anxiety had a higher prevalence of NSSI, 10 times the odds (95% CI 9.4-11.5) of suicide ideation, 28 times the odds (95% CI 23.8-33.1) of suicide ideation, with planning or attempt, and 47 times the odds (95% CI 31.1-71.4) of suicide ideation, with planning and attempt, compared to students with none/minimal depression and/or anxiety symptoms and no mental health condition diagnosis. LIMITATIONS: We could not clinically confirm depression or anxiety diagnoses nor infer causality of associations in this cross-sectional study. Future longitudinal studies are needed to establish temporality. CONCLUSIONS: Mental health condition diagnoses and moderate/severe symptoms of depression and/or anxiety were strongly associated with suicidality among college students. These findings identify potential opportunities to further understand and address the mental health needs of college students.

Reducing food insecurity and improving fruit and vegetable intake through a nutrition incentive program in Michigan, USA.

BACKGROUND: Nutrition incentive (NI) programs increase the purchase of fruits and vegetables (FVs) among low-income participants. Double Up Food Bucks (DUFB) is a robust statewide NI program in the United States. The purpose of this paper is to report findings from DUFB in Michigan describing the factors related to FV intake (FVI) and food insecurity among participants in a NI program. METHODS: We administered a repeated cross-sectional survey with a convenience sample of DUFB participants at farmers markets and grocery stores (over the 2016, 2017, 2018 seasons). The survey was conducted online via paper-pencil. Descriptive statistics were calculated for all variables. A logistic regression model estimated household food insecurity and a linear regression estimated FVI with DUFB use/perceptions, sociodemographics, and health status as independent variables (significance level = p < 0.05). RESULTS: Descriptive results revealed that participants that completed surveys at grocery stores tended to be more racially-ethnically diverse and younger than participants that completed surveys at farmers markets. Participants with lower length of time participating in DUFB (i.e., lower dose) (p < 0.001), greater FV purchases (p < 0.05), and lower perceived health status (p < 0.001) tended to report being food insecure more frequently. Participants with increased length of time participating in DUFB (p < 0.05), greater FV purchases (p < 0.001), being male (p < 0.01), and greater perceived health status (p < 0.001) tended to report higher levels of FVI more frequently. CONCLUSIONS: Longer participation in DUFB leads to improved outcomes with FVI and food security, suggesting that NI programs do have the intended positive impact they were designed to achieve.

Digital media use and suicidal behavior in U.S. adolescents, 2009-2017.

U.S. adolescent suicidal behavior and digital media use prevalence have contemporaneously increased this decade in population-level ecological analyses. The purpose of this study was to determine whether these two trends are directly associated by using multi-year person-level data to test whether the association of year with suicidal behavior was mediated by digital media use. Data were from the Youth Risk Behavior Surveillance System (2009-2017), a nationally-representative biennial cross-sectional self-report survey of U.S. students (N = 72,942). Mediation analysis was used to estimate the proportion of cross-year changes in suicidal behavior that were mediated by concurrent changes in leisure-time digital media use. Past-year suicidal behavior in 2011 (19.6%), 2013 (20.4%), 2015 (21.7%), and 2017 (20.5%) increased relative to 2009 (17.1%). Hours of daily digital media use in 2011 (mean[SD] = 2.65[1.86]), 2013 (mean[SD] = 3.02[2.08]), 2015 (mean[SD] = 2.97[2.12]), and 2017 (mean[SD] = 3.01[2.18) increased vs. 2009 (mean[SD] = 2.31[1.81]). The association of survey year with suicidal behavior was mediated by digital media use-20.5%(95%CI = 16.2, 24.8), 34.3%(95%CI = 24.5, 44.1), 22.8%(95%CI = 17.3, 28.0), and 41.4%(95%CI = 33.9, 49.5) of cross-year suicidal behavior prevalence increases (vs. 2009) for 2011, 2013, 2015, and 2017, respectively, were mediated by concurrent digital media use increases. Therefore, small proportions of the 2009-2017 increases in U.S. adolescent suicidal behavior are associated with concurrent increasing digital media use trends. Further exploration of these trends is warranted.

COVID-19 associated Multisystem Inflammatory Syndrome in Children (MIS-C) guidelines; revisiting the Western New York approach as the pandemic evolves.

Multisystem inflammatory syndrome of children (MIS-C) continues to be a highly concerning diagnosis in those recently infected with SARS-CoV-2. The diagnosis of MIS-C cases will likely become even more challenging as vaccine uptake and natural immunity in previously infected persons leads to lower circulating rates of SARS-CoV-2 infection and will make cases sporadic. Febrile children presenting with cardiac dysfunction, symptoms overlapping Kawasaki disease or significant gastrointestinal complaints warrant a thorough screen in emergency departments, urgent care centers, and outpatient pediatric or family medicine practices. An increased index of suspicion and discussion regarding higher level of care (transferring to pediatric tertiary care centers or to intensive care) continues to be recommended. Herein we outline a broad approach with a multidisciplinary team for those meeting the case definition and believe such an approach is crucial for successful outcomes.

An ounce of prevention is worth a pound of cure: considerations for pharmacists delivering the National Diabetes Prevention Program

Prediabetes is highly prevalent in the United States affecting over 88 million adults. In 2010, the Centers for Disease Control and Prevention (CDC) established the National Diabetes Prevention Program (NDPP), an intensive lifestyle program consisting of a 16-lesson curriculum focused on diet, exercise, and behavior modification, with the ultimate goal to reduce progression from prediabetes to diabetes. Despite tens of millions of adults potentially qualifying to participate in the program, the uptake of the NDPP has been exceedingly low. As a result, the CDC has focused its efforts on engaging with local health departments and community partners, including community pharmacies, across the United States to scale-up enrollment in the NDPP. In this commentary we discuss factors affecting implementation of the NDPP in community pharmacies and other settings where pharmacists practice, including training, space, personnel, recruitment and enrollment, retention, and sustainability (AU)

Knowledge and attitude of the community towards epilepsy in Northwest Ethiopia: A huge gap on knowledge and attitude of the community.

BACKGROUND: Misconception about epilepsy in Ethiopia is higher which in turn affects overall quality of life of the individuals. This research was aimed to assess knowledge and attitude of the community towards epilepsy in Northwest Ethiopia. METHODS: A community-based cross-sectional study was conducted. Data was entered by Epi data version 4.2 and analyzed by SPSS version 24. Descriptive and analytical statistical procedures, with 95% confidence interval were employed and significance level was determined at p-value < 0.05. RESULT: A total of 782 respondents were participated with the response rate of 96.1%. About 66.2% of respondents had poor knowledge and 67.0% had unfavorable attitude, towards epilepsy.In multivariate logistic regression, younger age, rural resident, not knew someone with epilepsy, did not have witness of seizure episode, and did not take prior training were associated with poor knowledge. Male sex, rural resident, did not know someone with epilepsy, did not have witness of seizure episode, did not take prior training, and had poor knowledge were associated with unfavorable attitude towards epilepsy. CONCLUSION: Majority of participants had poor knowledge and unfavorable attitude. Public education about epilepsy is recommended to modify misconceptions and to promote positive attitudes.

A case of Cryptococcus gattii infection in South Carolina: A possible challenge to known endemicity.

In the United States, C. gattii is considered to be endemic to the Pacific Northwest and although uncommon, additional cases have been documented in other regions including the Southeastern United States. While it has been hypothesized in the past that C. gattii may be endemic to the Southeastern United States, there remains a paucity of evidence. Here, we present a patient with no history of HIV/AIDS and no organ transplant and document the course of his disease and presentation. There were no adverse long-term neurological outcomes in this patient and the combination of steroid use, antifungal agents, and cerebrospinal fluid drainage resulted in his discharge from the hospital after 12 days. This patient's subacute presentation with vague neurological symptoms highlights the importance of understanding the treatment of rare causes of meningitis.

Dermatology residency research policies: A 2021 national survey.

BACKGROUND: In this follow-up study to previous work, the authors survey the availability of key measures and resources pertaining to residency research in U.S. Accreditation Council for Graduate Medical Education-accredited dermatology residency programs, including potential policy changes following the COVID-19 pandemic. OBJECTIVE: The chief objective of this survey was to evaluate and compare dermatology programs' resident research requirements and guidelines. METHODS: This cross-sectional study employed a 13-item survey administered online in early 2021 to assess the degree to which dermatology residency programs require and support their new physician graduates in scholarly research endeavors. RESULTS: A total of 32 program directors representing 30 dermatology residency programs (30 of 138 accredited programs contacted [22%]) responded to the survey. Almost all programs described quality improvement project requirements for residents and were able to provide funding for resident conference participation. Most programs also reported resident publication requirements and the availability of research electives. However, the vast majority did not have required research rotations or a formal mentorship program. The COVID-19 pandemic did not have a substantial impact on residency research requirements. CONCLUSION: Our survey provides objective data about the current dermatology resident research requirements across the United States. These findings may prove valuable to prospective applicants, residency programs, and accrediting agencies in improving, advancing, and structuring dermatology residency guidelines and resources with the aim of encouraging new physician trainees to pursue research.

Lessons learned from implementing the Supplemental Nutrition Assistance Program Education Small Corner Store Project in Los Angeles County.

As part of the federal Supplemental Nutrition Assistance Program Education (SNAP-Ed) in Los Angeles County (LAC), corner store conversions (CSCs) were an integral part of a broader, more coordinated effort to improve nutrition and to prevent obesity in low-income populations. To date, little is known about this experience in LAC. The present study addresses this gap by describing lessons learned from implementing the SNAP-Ed Small Corner Store Project (SCSP) in this region. The project, which began in 2013, sought to scale CSCs in underserved communities of LAC, employing behavioral economics (e.g., prominently displaying healthy foods at checkout aisles or using in-store signage to promote healthy options) to encourage patron selection of healthier food items. Results from an assessment of the SCSP suggest that for CSCs to do well, careful considerations should be given to factors such as time (e.g., amount of staff time dedicated to the effort), staff capacity (e.g., # staff available to assist), and available resources that can be leveraged (e.g., support from community-based organizations). For some stores, inadequate food distribution or a lack of capital improvement infrastructure (e.g., refrigeration for fresh produce/storage of excess food that can be repurposed) were key barriers that required additional funding. Although local efforts that incentivize small businesses to undergo CSCs may initially nudge store owners to participate, increasing overall consumer demand for healthier food products (i.e., so as to help maintain sales volume) remains a key to sustaining store conversions long after SNAP-Ed resources are gone.

Promoting congregant health in faith-based organizations across Los Angeles County, 2013-2016.

The Los Angeles County Department of Public Health (DPH) launched the Nutrition Education and Obesity Prevention (NEOP) Project in fall 2013. As the local arm of the Supplemental Nutrition Assistance Program Education (SNAP-Ed), this project partnered with faith-based organizations (FBOs) in Los Angeles County to implement policy, systems, and environmental change interventions (PSEs) at selected church sites, alongside the usual delivery of health education. A 2-part programmatic assessment was conducted to better understand how the NEOP Faith Based Project at one of the FBOs was implemented during the 2013-2016 SNAP-Ed funding cycle. A qualitative component (key informant interviews) sought to understand and describe the PSE implementation process at each of the participating church sites, whereas the quantitative component (surveys) focused on assessing congregant perceptions about their awareness of the PSEs, their knowledge and beliefs about health, and their self-reported health behaviors after exposure to onsite changes. Among congregants who participated in the survey, 52% expressed desire for more health education classes. However, only 37% reported being aware of them at church sites that hosted them. When asked to compare their behaviors for "today" versus 6 months ago, more than half reported greater interest in eating more fruits and vegetables (66%), choosing water over soda (69%), and becoming more physically active (59%). Results from the NEOP Project have implications for how local health departments could partner with FBOs to outreach and promote health among congregants, particularly for those who are at high-risk of diet-related diseases due to poor nutrition and obesity.